Purpose
The aim of our study was to identify differences in the time taken to achieve the
minimum clinically important difference (MCID), substantial clinical benefit (SCB),
and patient-acceptable symptom state (PASS) following primary hip arthroscopy for
the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different
body mass index (BMI) categories.
Methods
We conducted a retrospective comparative study of hip arthroscopy patients with minimum
2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight
(25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified
Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative.
MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2
and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement
of each milestone was compared using the interval-censored EMICM algorithm. The effect
of BMI was adjusted for age and sex using an interval-censored proportional hazards
model.
Results
285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight,
and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement
for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to
PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30).
Conclusions
Class I obesity is associated with delays in achieving a literature-defined PASS threshold
after primary hip arthroscopy for FAIS. However, future research should consider incorporating
PASS anchor questions to determine whether obesity truly carries a risk of delayed
achievement of a satisfactory state of health as it pertains to the hip.
Level of Evidence
III, retrospective comparative study.
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Article info
Publication history
Published online: February 19, 2023
Accepted:
January 31,
2023
Received:
June 28,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: T.Y. reports personal fees from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2023 by the Arthroscopy Association of North America
